Now ,CGHS Beneficiaries will get Treatment at Private Hospitals without Referral Letter

Published Date - 12 February 2018 03:18:05 Updated Date - 12 February 2018 03:19:16

New Delhi, Dec 7 Beneficiaries of the Central Government Health Scheme (CGHS) can now undergo treatment at any empanelled private hospital without the requirement of a referral or permission letter.

The decision was taken after the health ministry received a lot of representations for simplification of procedures for undergoing treatment at private hospitals empanelled under the scheme.

Earlier, central government employees and their dependents could undergo specific treatment procedures at private hospitals after being prescribed by medical officers under the scheme.

"It has now been decided that CGHS beneficiaries are allowed to undergo treatment at private hospitals empanelled under the CGHS of specific treatment procedures listed under CGHS rate list...Without any requirement of any other referral (permission) letter," according to an order issued by the health ministry.

According to an office memorandum which has been issued to all the ministries and departments of the central government, private empanelled hospitals shall perform the treatment on cashless basis in respect of pensioners, former parliamentarians, freedom fighters and regular employees who are at present eligible for credit facility.

"They shall enclose the prescription issued by government specialist or a CGHS medical officer in original, along with the hospital bill submitted to the competent authorities," said the order.

Previously, one had to consult at a local dispensary, from where the patient had to be referred to a bigger government hospital where, with the permission of a specialist, the paperwork had to be done to avail the treatment at a CGHS-empanelled private hospital or refer the beneficiaries to any particular hospital, according to the new order.

 

Need to Change Rules for CGHS Beneficiaries

Previously, central govt. employees / pensioner or their dependents have to take prescription of the CGHS Medical officers to undergo treatment at the CGHS em-paneled private hospital. The whole process was difficult as the individual has to firstly consult a local dispensary. Afterwards with the permission of specialist, candidates have to complete the paperwork to avail treatment.

According to the data of Health Ministry, there are a total number of 949 general hospitals in India which includes dental and eye care hospital. Subsequently, there are 118 general hospitals, 104 eye care and 52 dental care hospitals in Delhi alone. In addition to this, Delhi also has 61 diagnostic centers under CGHS category.

So to ease the process of getting treatment, there was a need to change the existing rules. So, the Health Ministry has decided to change the rules to simplify the whole process.

Facilities under Central Government Health Scheme (CGHS)

Under the CGHS and OPD treatment, the facilities available are as follows:-

According to Health Ministry, central govt. will provide cashless treatment to the pensioners and other eligible beneficiaries. Subsequently, all the patients admitted in emergency in private hospitals will get reimbursement of expenses. Furthermore, central govt. will also provide reimbursement of expenses for purchasing hearing aids, artificial limbs and appliances.

New Order for CGHS Beneficiaries

a) According to the new order, government employees must enclose prescription of government specialist / CGHS Medical officer (original) for submission of medical claim to the concerned ministry / department / office for reimbursement.
b) The job of the CGHS medical officer / government specialist will not refer the candidates to particular hospital by name. Subsequently, they will specify the treatment procedure and have to mention “referred to any CGHS em-paneled center”.

 

— To see the Central Government Health Scheme in detail, please click the link given below:-
Central Government health Scheme (CGHS)


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